Introduction
Obesity has emerged as a worldwide health problem and more incidences are reported from the developed countries. This paper presents the vulnerability of the problem, gives an evidence based approach applied for the reduction of childhood obesity among school children, analyses the assumptions of society with regard to the problem, depicts reasonable solutions for obesity with a critical reflection and describes some of the alternative solutions for the reduction of obesity.
Articulation of the problem of obesity
Obesity, if unchecked, could become a primary cause for major health hazards, which could even impede continuous good health and longevity of persons.
Though a world wide health problem, lately there is a significant rise in obesity in the developed nations. Obesity is a condition of fat contents in body being in excess, causing many health problems and reduced life expectancy. Obesity increases the risks of diseases, such as, cardio vascular diseases, type II diabetes, cancer and osteoarthritis. It has become a major global health problem of our time affecting people irrespective of sex, age and region. According to the Report of World Health Organization, there are one billion adults who are overweight and 300 million among them are diagnosed as clinically obese. Why the problem of obesity increases? The researchers say that there are number of factors interconnected with the vulnerability of the problem, such as, economical factors, genetic factors, social factors, ethnic factors, factors related to diet etc…. Increased intake of energy-dense food, food lacking nutrition, food that contains more sugar and saturated fats, increased intake of food and less physical activity are some of the factors that lead to the development of the problem that related to diet. The obesity rates show the three-fold increase of obesity after 1980 in some parts of North America, Eastern Europe, Australia, China, Pacific Island, United Kingdom etc. and the obesity leads to the development of other health problems.
Globally, twenty two billion children who are below 5 years old are reported to have obesity. It is estimated that the developed nations are spending two to six per cent of their total health care cost for the treatment of obese people. Findings of WHO are the evidence for this. “The prevalence of obese children aged 6-to-11 years has more than doubled since the 1960s. Obesity prevalence in youths aged 12-17 has increased dramatically from 5% to 13% in boys and from 5% to 9% in girls between 1966-70 and 1988-91 in the USA. The problem is global and increasingly extends into the developing world; for example, in Thailand the prevalence of obesity in 5-to-12 year olds children rose from12.2% to 15-6% in just two years.” (Global strategy on diet, physical activity and health, 2009, The Extend of the problem, para.2). Although their website has mentioned the depth of the problem, yet not much has been offered regarding control and treatments of obesity.
The prevalence of overweight and obesity is more in America and 133.6 million adults are confronting this problem. Among them, 65 million adults are women and 68.6 million are men. There are 112,000 deaths in United States due to obesity and the total cost spent for the health care of the obese people is $117billion. The lost productivity of overweight people in terms of cost, due to loss of working days and restricted activity is $ 3.9 billion in the United States. There are a set of reasons for the development of obesity. They are improper diet, less physical activity, genetic factors, medical and psychiatric illness and social determinants.
There are set of methods to measure obesity. A laboratory technique which is mostly used is multi-scan computerized tomography which measures the fat of the body and the distribution of the fat through the body and it gives the accurate data on the body. The well used non laboratory techniques to measure the fat of the body are skin fold test, bioelectrical impedance analysis and body Mass Index (BMI). Four methods used in the clinical practice to measure obesity are body mass index, weight-for-height tables, waist circumference and waist to hip ratio.
Evaluation of value-related perspectives about obesity
Before we go into the detailed study of obesity, it is necessary to know what causes this. There cold be a host of reasons that could give rise to obesity, from young people, teenagers, adolescent, middle aged and old people. While lifestyle and dietary habits provide important contributions, there could be other psychological, physiological and physical aspects that contribute to obesity. The consumption of diet having high amount of saturated fat, salts and sugary contents are seen as major culprits, as is a sedentary and exercise free lifestyle.
The major evaluation that needs to be considered would be at what stage the obesity has developed in individuals and how it could be controlled, or monitored with better medication, healthy habit free life style and lot of exercises and “medication treatment of obesity” that are realistic programs that could benefit the patient. (Obesity (weight loss), 2009, p.8, para.1). Indeed, the value related perspectives help to control the prevalence of the problem due to obesity. The community envisages the desired eating patterns, health related concerns, and ways of activities that are supposed to be carried out by the individuals. At the same time, there are social constraints for a person to do or not to do in accordance with the perspectives of the community. These values necessarily help to live a healthy life in the community. There are cultural and ethical outlook towards obesity and no society demands the people to be obese. There is a negative prejudice or bias in every society with regard to obesity. It is certain that the prejudice influences the behavior of overweight people. The major prejudices about the overweight people are that they are lazy and stupid in their nature and they do not have confidence, self responsibility and control. Overweight people are disregarded in terms of profession, education, and other social activities and recreation and even they are harmed by others. The perspectives of the society require the person to control the body structure.
Evidence based approach to address the issue of childhood obesity
Medscape medical news depicts about evidence based program for obesity. This program helped the children to adopt healthier practices in life. It was a multidisciplinary childhood obesity reduction and intervention program including pediatricians, dietitians, nurses, psychologists and behaviorists. All these professionals participated in the designing and teaching the children on this program. Ms. Lam, who is an educator in Permanente health care organization in California, designed this program to involve all the professionals in this program. 500 children participated in this program and their mean age was 9.08 years. The duration of this program was six weekly educational sessions and both parents and children were involved in this session. Each session takes 1.5 hours. 30 minutes are granted for physical exercise, 30 minutes for nutrition and 30 minutes for behavior change education. 30 minutes for nutrition includes providing knowledge about planning meals, age specific meals and making nutritious and healthy food. Behavior change session for 30 minutes gives emphasis on implementation of change, making accurate objectives and cultivating good habits that are useful for the reduction of childhood obesity. Parents also received information on obesity and the related health problems. “The researchers followed up the participants at 1, 6, and 12 months after the last educational session. Results at 6 months revealed statistically significant changes in children’s behavior. Fruits and vegetables consumed increased from 2.3 to 2.8 servings (P <. 01) and soda and fruit juice consumption decreased from 2 to 1.54 servings per day (P <. 05). Junk food consumption decreased (P <. 01), and hours spent watching TV or playing video games decreased from 3.1 to 2.92 hours (P <. 01). Children increased their hours of exercise per week from 2.25 to 2.55 hours (P <. 05).” (Kahn, 2006, Evidence- based program helps fight childhood obesity, para.4). Many valuable opinions of well known people have been included in this source. In addition to this change, it is reported that there was a remarkable change in the body mass percentage of the children.
Strengths of this program
The main strengths of this program were it included a multidisciplinary team of health care professionals including pediatricians, dietitians, nurses, psychologists and behaviorists. It helped to give an integrated perspective to the children and parents on the issues of obesity and health related problems. The program emphasized on three factors, namely, physical exercise, behavioral change and imparting knowledge that are the main focuses of every childhood obesity program.
The results and outcomes of this program justified its implementation in that a high degree of success in implementing good food habits and weaning them away from undesirable junk food, too much watching TV, etc. was achieved. “Results at 6 months revealed statistically significant changes in children’s behavior.” (Kahn, 2006, para.5).
Weaknesses of this program
The weaknesses of the program were that time was a constraining factor when health care practitioners tried to inculcate health behavior among parents and their wards. Even though there is a multidisciplinary team for the program, it should be noted whether experts have sufficient time to spend for the children. Thus it is necessary to have a more focused and time drawn program for tackling obesity issues among children.
Underlying assumptions
The underlying assumptions are that such evidence-based programs could help fight against children obesity. While this could be realistic on short term basis, how far this could be effective on long term basis remains to be seen. A lot of dietary and environmental changes take place during the long term and this needs to be inculcated in this program.
The evidence based approach gives a detailed description about the problem of the disease, how to control the problem, how to prevent the problem and how to treat the problem. The methods that are used in the interventions will provide the correct steps to deal with the new problem. There are so many evidence based approaches conducted in the schools to control the obesity problem, different programs conducted by the companies for the good health of the employees and other evidence based programs in the society in order to mitigate the problem of obesity. ‘Take action’ is one of the programs designed in California to keep the health of the employers well through regular exercise and intake of food that contains protein.
The reasons of obesity
It is very important to discuss about what we eat when we discuss about obesity. Now the fast food industry has become one of the major fast growing business areas. There are many companies which supply fast food not only in restaurants but also in cinema halls, schools, trains, zoos, airports, gas stations etc……. This kind of diet makes great contribution to the increase in obesity. Massive consumption of alcohol and soft drink is another reason for increasing weight.
The weight increases when there is no balance in the energy intake and expenditure. Energy expenditure means the burning of calorie. It can be done only by increasing physical activities. But, the rate of energy expenditure is decreasing day by day. Now, even the children don’t walk to schools. They just prefer car or motor bike. When we spend our free time for watching television or playing computer games there is no energy expenditure. These kinds of habits cause the existence of massive fat in the body. The reduced level of fat oxidation can also gain weight in some people.
Life style and obesity
Sometimes, the problems related to obesity would not be apparent in early childhood. It becomes a threat for his life when they grow up. It points out the need of preventing obesity during the early childhood itself. In children, problems of obesity don’t end with some simple physical illness. Sometimes, it leads to serious health issues like heart deceases. If we make a study on the health of people of today and 1970’s it can be seen that increase in the childhood obesity is terrible. The main reason is change in life style.
Obesity as an economic issue
Obesity is just not a health issue. Some times it can be economic too. The treatments for obesity and related diseases are very expensive. Indeed, obese people cannot work long time as they get tiered easily. Obese people will be just idle after retirement. They will have to live as financial burden for the family. So, lack of productivity causes great economic losses. Because of their inactive life and unshaped body, commonly obese people would be depressed. Especially young women with poor body image are at this risk.
People have started to understand the issue. Still many of them are not ready to regulate the consumption of food. It happens because the fast foods can make people addicted to them. It is very difficult to put a hard restriction on our diet suddenly. Finding time for physical activities is also very difficult in this busy life.
Problems with working people
It is very difficult for the working people to care their health. Most people don’t spend much time in their home because of busy work. Then they can depend only on fast food restaurants. Some big companies provide healthy food for their employees through their canteens. But small companies cannot provide this facility as it is very expensive.
How to reduce obesity
Balancing of energy intake and expenditure is the first thing to be done to reduce obesity. So, the diet of the patient should be monitored. The dishes that include carbohydrates rather than too much fat would be better for obese people. The book “Management of Obesity and Related Issue” by Peter G Kopelman discusses about the importance of carbohydrates in diet. Kopman has tried to cover all the area related to this issue. In the book he says carbohydrate is known to have a greater satiating effect than fat and its intake is quite closely regulated by the body. “Further more high carbohydrate meals appear to keep hunger suppressed for longer than meals high in fat.” (Kopelman, 2001, p.140). This book also discusses about the need of fruits and vegetables in diet. Fruits and vegetables contain lesser amount of fat. Indeed, they contain vitamins, minerals, beta-carotene etc. So, this information leads to the need for replacing fast food with these kinds of food items. Consumption of alcohol and soft drinks also can be a major factor for increase in weight. As it is very difficult to give up consumption of alcohol and soft drinks, the patients have to take an extra effort in order to achieve a better health condition. Requirement of physical activities is very high in obese people. It is very easy to deal with obesity if we start the remedies in childhood itself. Most of the children spend their spare time watching television or playing computer games. Some people also have the habit of taking snacks while watching television. This habit can cause obesity very easily. Gradually, their tendency to participate in physical activities reduces. Later, such children would not have any interest in playing foot ball, cricket or any other games. Primary schools can play a great role in lowering the rate of obesity. For that, physical exercise should be made a compulsory part of education.
The impact of television and computer is very high in children compared to adults. There are many children who spend 7 or 8 hours continuously in front of computer or television. This is the major reason for childhood obesity other than genetic reasons. The book “The obesity epidemic: science, morality, and ideology by Michael Gard, Jan Wright says about the requirement of physical activities in children. It says “opportunities for spontaneous play may be the only requirement that young children need to increase their physical activity. Reducing the amount of time that children are allowed to watch television is one strategy that offers children opportunities for activities, and it is likely to alter request for advertised food as well.”
(Gard, & Wright, 2005, p.64). This book explains well about the importance of physical activities. It also explains how our life style should be changed to tackle with obesity.
Like children, the adults also like to have a comfortable life style. Most people are not even ready to walk some distance. Instead of that, they just choose their car to save more time. In modern world, most jobs are computer related. So, there are not many chances to have any kind of physical activities in office too. These types of people have to take an extra effort to balance between energy intake and energy expenditure
Alternative solutions
The need for inculcating good food habits among school children should begin at school, and teachers need to inform children regarding which kinds of food are good for their health and which are not. Thus the undertaking of mass education program reinforced by advertisements and publicity could go a long way in educating the children about the benefits and dangers of the food and drinks they consume.
Naturally, they would then remember what particular item to buy when they go to market next time. So, the government should be ready to ban these kinds of advertisements. Indeed, they can also create awareness in people about the consequences of obesity through various programs. If they are ready to urge people to use fat free food and drinks, it would be great. The small companies which are financially not sound can arrange a mess room for the employees. For that they just need to arrange a room. An outer company can arrange healthy food for the employees.
Other than controlling diet and increasing exercise bariatric surgery can be an effective solution for serious obesity. “Bariatric operations are major gastrointestinal procedures which alter the capacity and/or the anatomy of the digestive system.” (Introduction to bariatric weight loss surgery, 2007).
Baratric surgery has been mentioned as an alternative solution for the problem. The procedure of this surgery, the results etc. have been explained well. But there is no much description about the side effect of this surgery.
Strength and weakness of the sources
The article explains obesity as a global issue. The readers can get a clear idea about how this problem affects people in different parts of the world. The explanations about various diseases as consequences of obesity make aware of the reader about the depth of the problem. But there are no much details about how it varies in different countries. In well developed countries like America overuse of vehicles and fast food habit have very big role in increasing obesity. But that is not the case of many developing countries. So a country wised study is essential to understand the problem.
Medscape today analyses the problem based on the study they conducted in more than 500 children. The study emphasizes on childhood obesity. Its necessary to make different kinds of studies on adults and children as the reasons for obesity can vary in both. The result of the study can be used as reference for further studies on the issue. As the participants are from different countries variation in the impact of the issue can be observed corresponding to cultural variation. But one of the main draw back of the study is that there were no children to represent countries like Japan, India, china etc… The depth of the problem cannot be measured accurately observing people in a few countries as it is a global problem. Indeed it was a program that observed people within a specific time frame. Obesity is such a problem that can occur any time in life. The disease may not be apparent always. So it is not fare to take the result of a study that has conducted in a time frame of one or two years as a major reference for the researches on obesity.
The book, Management of Obesity and Related Disorder focuses on different aspects of obesity. The author Peter G. Kopelman has been successful in explaining in how food habits and lack of exercises cause obesity. He suggests fruits, vegetables and other vitamin rich foods as solution for obesity. But there is not much specification about how these kinds of food items can be consumed as in many countries people fat rich food is a part of cultural food habits. The consumption of alcohols is another reason for obesity. But there is no suggestion for solution or treatment for drunkards to stop their habit.
Gard, M., & Wright, J. has made a vast study on the topic in their book, The obesity epidemic: science, morality, and ideology. Over use of computer and television is the main reason for reducing exercise. Fast food habit and consumption of soft drinks and alcohols, reluctance in participating in sports and other physical activities are the main problem according to author. The book emphasizes on the need of change in lifestyle and food habit.
Conclusion
So, like all other diseases, it is better to prevent obesity rather than going for treatment after being obese. All we need to do to prevent obesity is just change the life style. That means, avoid consumption of fat rich food items, soft drinks, alcohol etc. Make physical activities a part of life. If people are ready to regulate their life style, we can make obesity a mere history
Reference
Gard, M., & Wright, J. (2005). The obesity epidemic: science, morality, and ideology. Routledge. 64.
Global strategy on diet, physical activity and health: Obesity and overweight: The Extend of the problem. (2009). World Health Organization. Web.
Introduction to bariatric weight loss surgery. (2007). Bariatric Surgery Guide. Web.
Kahn, K. (2006). American public health association 134th annual meeting and explosion: Evidence- based program helps fight childhood obesity. Medscape Today. Web.
Kopelman, P G. (2001). The management of obesity and related disorder: Why more carbohydrate. Informa Health Care. 140.
Obesity (weight loss) (cont.): What is the role of medication in the treatment of obesity?. (2009). Medicine Net.com. Web.